Should the navy nurse who refused to force feed Guantanamo prisoners be discharged?

Great Debates
1

An unnamed navy nurse is currently in danger of being discharged by a formal board of inquiry for refusing to force feed Guantanamo prisoners, believing the practice to be in direct contradiction of his/her professional ethics. The nurse may have a point.

The above is from a New York Times article on the subject, but there are many news stories you can find using Google. Other medical associations have made similar statements.

I want to stir the pot a little bit more and mix it up with the pharmacists who refuse to issue contraceptives. My reason: reading the media and looking at online commentary it looks like the standard positions are reversed in this case; conservatives (who laud the pharmacists for their moral fiber) think the nurse should be discharged and even punished. Liberals seem to think the nurse is right in his/her ethical stance and should not face retaliation.

What say you? Are the two cases different? How do you feel about the pharmacists and this nurse? Should they both face punishment for refusing to do their duty. Both be applauded for standing up for their principles? Or is your position more nuanced?

For myself I am more empathetic with the nurse than I am with the pharmacists, but I think nobody should be forced to do tasks that are against their moral principles. I do however believe that both the nurse and the pharmacists can and maybe should face firing for their moral stand.

2

This is literally insubordination

3

They are both pretty different to me.

The pharmacists aren’t in the military, so for one there is no such thing as “failure to obey orders” as a criminal offense for pharmacists. Criminal offenses related to pharmacy would tend to be improper dispensing or things like that.

My personal opinion on pharmacists is their role as experts in prescription medications should be constrained solely to that. For example if they catch something in a prescription (like a dangerous drug interaction), that’s where they need to use their professional discretion and get involved. If they just have a moral objection to the drug someone is using I do not think they should be declining to fill prescriptions.

My opinion on whether or not pharmacists should be punished is a simple one: if their actions violate the State Board of Pharmacy regulations on pharmacist behavior, then they should face professional punishment. If it doesn’t, then they shouldn’t be punished obviously since they aren’t breaking their professional rules. I’d be fine if their employer chose to fire them for it, though, if their actions violate their policies (i.e. a big chain pharmacy that requires you to dispense birth control firing a pharmacist for refusing, I’m fine with that.)

My opinion on the nurses is simple. They were given a lawful order, failure to follow it is a crime. They should face punishment, and will and are. If that order conflicts with professional organization standards the choice is pretty obvious. For a member of the military a legal military order trumps your professional board guidelines or rules.

FWIW is this an actual licensed nurse? A lot of people called “nurse” in the military are not “real” nurses in the licensed/training sense, they may have a nursing type MOS but in a civilian medical terminology would be thought of more like orderlies or such. They have some medical hands on training and maybe some classroom stuff, but not enough to be registered nurses or anything. So they’re more the “common” definition of “nurse”, not the “professional” Registered Nurse type.

4

I see forced feeding of people as a form of torture and just as a doctor or pschologist has an ethical duty beyond military orders not to be part of torture, so does a nurse.

5

This is actually kind of the main question here. WAS the order lawful? I agree with btthegreat, this is tantamount to an order to torture a prisoner and therefore is not lawful.The nurse has a duty to disobey.

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No, it doesn’t. Or, if it does, what you are saying is that doctors and nurses cannot serve in the military without jeopardising their licences and exposing themselves to the legal consequences of malpractice.

Do you really want a military that can’t recruit doctors and nurses?

7

And my position on pharmacists is similar: If you don’t want to dispense contraceptives, don’t become a pharmacist. If you want to force feed people, don’t become a nurse. (Or any profession, really, torture isn’t legal. Become a serial killer instead.)

8

I think you are correct in this assessment. On the other hand, I see hunger strikes as a form of hostage-taking. The fact that the hostage-taker is the hostage is irrelevant.

9

What if Chaplains were ordered not to give last rites unless prisoners cooperated with intelligence gathering, or otherwise ordered to give favoritism to prisoners to cooperated?

10

I see a big difference between this case and birth control pills. Force feeding is a matter of professional ethics against forcing care without consent. The birth control issue is about personal ethics and** providing requested care**. I generally support individual care providers not being legally required to provide care that violates their personal beliefs. I acknowledge that gets messy when it creates a de facto unavailability of care that’s otherwise legal and professionally accepted. Still that dilemma about individual ethics vs care availability is an entirely different issue in my mind.

I could potentially have seen an argument that it was an unlawful order based on international conventions. That’s a messy case. ]It’s also not the case the nurse seems to have made. Which leads back to your point. :wink:

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:dubious: The nurse though? Yeah, when someone decides to commit to a profession that takes years of training to even begin they should know and accept all possible consequences unforeseen in the future of the career they’ve made sacrifices to peruse.

Every Park Ranger cadet better be prepared to mercy kill a dying child gored by a Black Bear.

12

My personal opinion is that the AMA has introduced politics into this argument. The declaration that forced feeding is a form of torture follows a similar declaration by the World Medical Association. This position was adopted in 2005. In my opinion, it doesn’t represent a real consensus that forced feeding is a form of torture but a political protest against the holding of prisoners at Guantanamo.

13

Pharmacists who refuse abortion to a woman are going against the will of the patient. A nurse who refuses to force feed a torture victim is complying with the will of the patent. They are the opposite situation, not the same one.

Forced feeding has been used as a form of torture for over a century at least.

14

Even in military medical training, do they cover force-feeding prisoners against their will, so that those in training can decide before it is too late whether they want to go down that path?

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So we have the following options.

  1. Let them all starve to death (as the hunger strikes are spreading down there) and face the wrath of the world for allowing them to die a cruel and inhumane death.

  2. Force feed them and face the wrath of the world for torturing the prisoners.
    Poor nurse, she is really caught in the middle of something she should not be forced to be part of.

16

Who has the right to order a nurse to do something against her morals and against the patient’s wishes? Her choice is to tell the military to pound sand and go to the private sector.

17

So do a few others. Here is the stance of the World Medical Association http://www.wma.net/en/40news/20archives/2006/2006_10/ "At its annual General Assembly in Sun City, South Africa, the WMA amended its guidance to physicians on the management of hunger strikers to make it absolutely clear that force feeding constitutes a form of inhuman and degrading treatment.

The new guidance in the revised Declaration of Malta, clarifying existing WMA policy, says that respect for patient autonomy must be weighed against medical interventions, which may or may not be in the hunger striker’s best interests. The final decision to intervene must take into account the hunger striker’s informed decision and must lie with the physician and not with any non medical authority.

Dr Otmar Kloiber, secretary general of the WMA, said:

This new guidance makes it absolutely clear that physicians should never be used to break hunger strikes through acts such as force feeding.
The clarification was necessary because there had been erroneous interpretations of the Declaration, making it seem to allow force feeding in the best interests of the patient, even when he had expressed wishes to the contrary. This interpretation appeared to contradict another WMA policy, the Declaration of Tokyo, which specifically stipulates that prisoners on hunger strike who have made an informed refusal of food shall not be artificially fed.
In clarifying this policy, delegates at the WMA Assembly emphasized that doctors working in prisons or the armed forces have exactly the same ethical obligations when treating prisoners as they do when caring for other autonomous patients."
here is the stance of the international Red Cross.
"…Red Cross investigators have visited the Guantanamo Bay detention facility during the hunger strikes, but Maurer refused to provide details, claiming the findings are confidential. But he did state that the ICRC and other international medical groups believe detainees should have the freedom to choose their own fate, and not be forced to endure painful force-feeding.
http://rt-tv.f29hgb.ru/usa/red-cross-guantanamo-maurer-770/

Here is the AMA letter to Chuck Hagel https://s3.amazonaws.com/s3.documentcloud.org/documents/694196/hunger-strikers-letter-04-25-13.pdf

And here is the stance of the UN office of Human Rights. http://www.france24.com/en/20130501-force-feeding-torture-un-law-guantanamo-hunger-strike/
Guantanamo
human rights
international justice
Americas
UN calls force-feeding ‘torture’ amid Guantanamo hunger strike

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© afp
Text by News Wires
Latest update : 2013-05-02
Force-feeding is “torture” and breaks international law, the UN’s human rights office said Wednesday, as 100 of the 166 detainees at Guantanamo Bay continue a months-long hunger strike. Twenty-one inmates are being force-fed through nasal tubes.

Force-feeding hunger strikers is a breach of international law, the UN’s human rights office said Wednesday, as US authorities tried to stem a protest by inmates at the controversial Guantanamo Bay jail.

“If it’s perceived as torture or inhuman treatment – and it’s the case, it’s painful – then it is prohibited by international law,” Rupert Coville, spokesman for the UN high commissioner for human rights, told AFP.

Out of 166 inmates held at the prison at the remote US naval base in southeastern Cuba, 100 are on hunger strike, according to the latest tally from military officers. And of those, 21 detainees are being fed through nasal tubes.

FRANCE 24 REPORTS ON GUANTANAMO

Coville explained that the UN bases its stance on that of the World Medical Association, a 102-nation body whose members include the United States, which is a watchdog for ethics in healthcare.

In 1991 the WMA said that forcible feeding is “never ethically acceptable”.

“Even if intended to benefit, feeding accompanied with threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment. Equally unacceptable is the force feeding of some detainees in order to intimidate or coerce other hunger strikers to stop fasting,” it said.
Here is a copy of the procedure the US Military at Guantanamo implemented. http://www.aljazeera.com/humanrights/2013/05/201358152317954140.html

Finally my own opinion. There is an absolute right for every competent adult to decide to refuse medical treaemtn, medication, nutrition or hydration regardless of whether it inconveniences the efforts of the US Military to exacerbate suffering, trauma or discomfort for its own agenda. Neither is the US government entitled to force people to live, because it is being embarrassed by their death.

The nurse is the only real moral authority in a place where such is lacking and there is military case law aplenty regarding the refusal to follow orders that abhor the conscience or constitute torture.

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  1. Subject people we have incarcerated for years to our justice system and foundation of human rights, not just our wrath.
19

Starting with your closing sincea point of strong agreement for me.

I’ve got less agreement on the implied applicability of the rest of your post.

I clipped a bunch here. It simply has nothing to do with justifying that the order was unlawful under UCMJ. The WMA stance is not international law. At best it’s a mitigating or extenuating circumstance for a commander or court martial to consider when assigning punishment if judicial action is pursued. It can also be considered by a separation board in determining whether to separate and how to characterize the discharge. It can inform governments on the best ways to implement accords.

We’re at least getting in the ballpark and this relates to the link I posted earlier. That’s an interpretation of the vague Geneva Convention language. It’s a common interpretation. The link I posted discussed concerns with no national implementation law or strong US legal precedent clarifying the “lawful” for the US military. There’s a case to be made there if this went to a judicial proceeding. From the story the command in is pursuing an administrative separation instead of a judicial proceeding. Maybe that’s because they wanted to spare the officer the chance of being found guilty in a court martial with far more serious effects (like turning big rocks into little rocks at a disciplinary barracks.) Maybe they didn’t want the distraction of a lengthy and politicized judicial proceeding. Maybe it’s a combination.

Maybe; it’s the most common application of the applicable accord. At this point the military is left holding the bag of negotiating the lack of clarity from either Congress or the Courts.

There’s case law aplenty that ignorance of an order being unlawful, when it clearly is ethically wrong, does not constitute a defense. Do you have any cites that show simple lack of ethics being an affirmative defense for unlawfulness of an order?

Incidentally this has been an issue for close to 9 years now. This 18 officer would have long since had their initial service obligation expire. They very likely could have resigned their commission in disagreement with the policy long ago unless they accepted an additional service obligation (for their own benefit). They didn’t. Their ethical objections obviously didn’t stop them from sticking around to draw their pay as long as someone else was doing the objectionable work. They only objected when their turn came.

20

I think this the crux of the argument. The AMA and WHO aren’t necessarily impartial arbitrators of medicine and ethics; they also traffic in political arguments and debates. Did they decide that force-feeding was innately unethical and therefore we should end it, or did they decide that they don’t like Guantanamo and that they’re going to declare unethical a necessary medical procedure to try and end American involvement there?